Temporal changes in the incidence and predictors of severe hypoglycaemia in type 2 diabetes: The Fremantle Diabetes Study

Abstract

Aim To determine the incidence of severe hypoglycaemia and its predictors in community‐based patients with type 2 diabetes studied between 2008 and 2013 compared with those in a cohort of patients with type 2 diabetes from the same geographical area assessed a decade earlier. Methods We studied 1551 participants (mean age 65.7 years, 51.9% men) with type 2 diabetes from the longitudinal observational Fremantle Diabetes Study Phase II (FDS2). Severe hypoglycaemia was ascertained as that requiring ambulance attendance, emergency department services and/or hospitalization. Cox proportional hazards modelling was used to determine predictors of a first episode of severe hypoglycaemia, and negative binomial regression was used to identify predictors of frequency. Results Sixty‐three participants (4.1%) experienced 83 episodes, representing an incidence of 1.34/100 participant‐years (95% confidence interval [CI] 1.08 to 1.67; vs 1.67/100 participant‐years [95% CI 1.31‐2.13] in the Fremantle Diabetes Study Phase I [FDS1]; P = 0.18). Those experiencing severe hypoglycaemia experienced one to four episodes in both cohorts. The independent predictors of incident severe hypoglycaemia in the FDS2 were: older age; higher educational attainment; alcohol consumption; current smoking; sulphonylurea/insulin treatment; prior severe hypoglycaemia; renal impairment; and plasma N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP). The same variables except smoking were associated with frequency of severe hypoglycaemia. Most of these risk factors paralleled those in the FDS1, but current smoking and plasma NT‐proBNP were novel. Conclusions The incidence and frequency of severe hypoglycaemia did not change between the Fremantle Diabetes Study phases but novel risk factors, including plasma NT‐proBNP, were observed in the FDS2.

Risk for Imbalanced Blood Glucose Pattern: Construct Analysis and Nursing Diagnosis Proposal

“…Ingesting small amounts of alcohol can impair the individuals’ ability to detect the onset of mild hypoglycemia, in which they are still able to adopt the appropriate measures, that is, ingesting carbohydrates (Richardson et al, 2005). Alcohol mediation on hypoglycemia awareness was verified in a group of patients with relatively high and intermittent alcohol consumption (Davis et al, 2019). The risk of hypoglycemia recurrence was increased due to inhibition of alcohol-associated gluconeogenesis, reducing the perception regarding hypoglycemia.…”

Analysis on risk factors of hypoglycemic consciousness disorder

“…When severe hypoglycemia lasts for more than 6~12 hours, it will cause irreversible damage to brain cells, leading to consciousness disorder and even death [5][6] . In healthy people, insulin secretion is inhibited and glucagon secretion is activated when the blood glucose level drops to 2.8~3.0 mmol/L; when it further drops to < 2.8 mmol/L, brain dysfunction will become obvious [7] . For non-diabetic patients, the diagnostic standard of hypoglycemia is blood glucose <2.8 mmol/L, while diabetic patients receiving drug treatment belong to the category of hypoglycemia as long as the blood glucose level is ≤s3.9 mmol/L [1,2,5] .…”

Trends of severe hypoglycemia in patients with type 2 diabetes in Korea: A longitudinal nationwide cohort study

“…At the same time, our study lacked important variables for glycemic control status, medication dosages and detailed information about disease duration. Despite these limitations, it is very important to know the current situation of SH occurrence, because there are still a considerable number of patients suffering from SH, and it could induce very serious clinical outcomes, especially in patients who are very old, fragile, and have long‐standing diabetes and multiple underlying advanced comorbidities 15 , 16 , 17 . In addition to comprehensive diabetes care, a more intensive, individualized and patient‐centered detailed approach with education for the prevention of SH should be emphasized in this high‐risk population of type 2 diabetes patients.…”